This proposal seeks continued funding for the North Carolina Breast Cancer Screening Program (NC-BCSP), a consortium of state and local public health agencies and universities whose primary purpose is to improve initial and repeat breast cancer screening rates among Black women over age 50 in a five county rural area in eastern North Carolina. During Years 4 - 8, the NC-BCSP will continue its mission of reducing the racial gap in breast cancer mortality through the pursuit of three primary alms; these represent continuation and expansion of the aims originally articulated for Years l - 3. The aims are to: 1) increase initial and repeat breast cancer screening with mammography by Black women ages 50 years and older living in five rural eastern North Carolina counties; 2) increase follow- up of positive screening mammograms; and 3) establish partnerships between health care providers and communities to maintain increased breast cancer screening and follow-up. The NC-BCSP aims will continue to be achieved through three complementary intervention components: InReach, OutReach, and Access. The Inreach intervention consists of activities to assist local health departments and rural community health centers with their delivery of up-to-date preventive services and to recruit "physician advocates" to help establish community-wide breast cancer screening plans among health care providers. OutReach intervention activities focus on enhancing community awareness of, and support for, screening older minority women by training selected women to be "lay health advisors" and retired or inactive nurses to be "nurse-advisors to counsel women with abnormal mammogram results. Access activities are designed to overcome structural barriers (transportation and cost) that prevent low income, rural women from getting mammograms. A major emphasis will be placed on institutionalizing and diffusing interventions and coordinating cross-study linkages with SPORE Project 2. We are using a quasi-experimental, pre/post test research design to evaluate not only change in mammography screening behavior but also in numerous barriers and attitudes women have toward breast cancer. For the pretest during the first cycle of the grant, hour-long, face-to-face, structured household interviews have been conducted with a sample of 2,000 women (1,000 White, 1,000 Black) over 50 years of age in the 5 intervention and 5 comparison counties. A post-test survey of this cohort of 2,000 women is planned for 1996 and again in the year in the addition, we are continuing to implement a process evaluation to measure more immediate outcomes agencies and among providers brought about by the intervention activities. Also, working with Project 2, we will monitor pre/post-test changes in size of breast cancers diagnosed among Black and White women in the five intervention and five comparison counties.